Clonal hematopoiesis in older patients with breast cancer receiving chemotherapy

Abstract Background The expansion of hematopoietic stem cells carrying recurrent somatic mutations, termed clonal hematopoiesis (CH), is common in elderly individuals and is associated with increased risk of myeloid malignancy and all-cause mortality. Though chemotherapy is a known risk factor for d...

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Published in:JNCI : Journal of the National Cancer Institute 2023-08, Vol.115 (8), p.981-988
Main Authors: Mayerhofer, Christina, Sedrak, Mina S, Hopkins, Judith O, Li, Tianyu, Tayob, Nabihah, Faggen, Meredith G, Sinclair, Natalie F, Chen, Wendy Y, Parsons, Heather A, Mayer, Erica L, Lange, Paulina B, Basta, Ameer S, Perilla-Glen, Adriana, Lederman, Ruth I, Wong, Andrew R, Tiwari, Abhay, McAllister, Sandra S, Mittendorf, Elizabeth A, Gibson, Christopher J, Burstein, Harold J, Kim, Annette S, Freedman, Rachel A, Miller, Peter G
Format: Article
Language:English
Subjects:
Aged
Breast cancer
Breast Neoplasms - drug therapy
Breast Neoplasms - genetics
Cancer
Chemotherapy
Clonal Hematopoiesis - genetics
Cyclophosphamide
Damage detection
DNA damage
Female
Hematopoiesis
Hematopoiesis - genetics
Hematopoietic stem cells
Hemopoiesis
Hormones
Humans
Malignancy
Mutation
Neutropenia
Older people
p53 Protein
Patients
Retrospective Studies
Risk factors
Solid tumors
Stem cells
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Summary:Abstract Background The expansion of hematopoietic stem cells carrying recurrent somatic mutations, termed clonal hematopoiesis (CH), is common in elderly individuals and is associated with increased risk of myeloid malignancy and all-cause mortality. Though chemotherapy is a known risk factor for developing CH, how myelosuppressive therapies affect the short-term dynamics of CH remains incompletely understood. Most studies have been limited by retrospective design, heterogeneous patient populations, varied techniques to identifying CH, and analysis of single timepoints. Methods We examined serial samples from 40 older women with triple-negative or hormone receptor–positive breast cancer treated on the prospective ADjuVANt Chemotherapy in the Elderly trial to evaluate the prevalence and dynamics of CH at baseline and throughout chemotherapy (6 and 12 weeks). Results CH was detected in 44% of patients at baseline and in 53% at any timepoint. Baseline patient characteristics were not associated with CH. Over the course of treatment, mutations exhibited a variety of dynamics, including emergence, expansion, contraction, and disappearance. All mutations in TP53 (n = 3) and PPM1D (n = 4), genes that regulate the DNA damage response, either became detectable or expanded over the course of treatment. Neutropenia was more common in patients with CH, particularly when the mutations became detectable during treatment, and CH was significantly associated with cyclophosphamide dose reductions and holds (P = .02). Conclusions Our study shows that CH is common, dynamic, and of potential clinical significance in this population. Our results should stimulate larger efforts to understand the biological and clinical importance of CH in solid tumor malignancies. Trial Registration ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03858322). Clinical trial registration number: NCT03858322.
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/djad065